Esophageal perforation (EP) is a rare, life-threatening condition associated with high morbidity and mortality. This study aimed to evaluate the clinical factors associated with mortality and to assess the predictive performance of commonly used clinical severity scoring systems, including the Pittsburgh Severity Score (PSS), ASA physical status classification, and quick Sequential Organ Failure Assessment (qSOFA) score, in patients with EP. A retrospective analysis of patients treated for EP at a tertiary referral center between 2023 and 2025 was performed. Survivors and non-survivors were compared using non-parametric tests. Effect sizes were calculated using Cliff’s delta and Cramér’s V. Receiver operating characteristic (ROC) analysis was used to evaluate the discriminatory performance of the PSS for mortality. Eleven patients were included in the study. Thoracic imaging findings (pneumomediastinum and pleural effusion) and clinical indicators of systemic deterioration showed large effect sizes for mortality. PSS was the only variable significantly associated with mortality (p = 0.033) and demonstrated a large effect size (Cliff’s δ = −0.80). An ROC analysis showed excellent discriminatory performance (AUC = 0.90), with a cutoff value of 6.5 predicting mortality with 100

Background Trans-thoracic impalement injuries are exceedingly rare and are associated with extremely high prehospital mortality. When a penetrating object traverses multiple thoracic compartments, rapid selection of a surgical approach that provides extensive exposure is crucial for safe assessment and repair. Case presentation A 48-year-old male construction worker sustained trans-thoracic impalement after falling onto an iron rod. The object entered the right posterior axillary line and exited through the left anterior chest wall. The patient was hemodynamically stable and transferred directly to the operating room. A clamshell thoracotomy was initially performed, revealing that the rod traversed the right upper lobe and coursed close to mediastinal vascular structures. To allow better evaluation of potential vascular injury, a partial median sternotomy was added. The rod was found to have penetrated the superior vena cava, which was tamponaded by the object itself. After placement of purse-string sutures at the entry and exit sites of the venous injury, controlled removal of the rod was achieved via pulmonary tractotomy. The sternum was reconstructed with wire sutures. The postoperative course was uneventful, and the patient was discharged on postoperative day 10. Conclusion In complex trans-thoracic impalement injuries involving both pulmonary and mediastinal structures, no single incision may provide sufficient exposure. A combined clamshell thoracotomy and partial median sternotomy offers excellent visualization of multiple thoracic compartments and may facilitate safe management of life-threatening injuries.

Journal Article Editorial comment: correlation between postoperative cognitive dysfunction and the extent of lung resection in lung cancer patients Get access Tevfik Kaplan, Tevfik Kaplan Thoracic Surgery Clinic, Ankara Etlik City Hospital, Ankara, Turkey Corresponding author. Thoracic Surgery Clinic, Ankara Etlik City Hospital, T3 Tower, Varlik Mahallesi, Halil Sezai Erkut Caddesi, 06170 Yenimahalle, Ankara, Turkey. Tel: +90-312-797-00-00; e-mail: tevfikkaplan@yahoo.com (T. Kaplan). https://orcid.org/0000-0002-4936-1515 Search for other works by this author on: Oxford Academic PubMed Google Scholar Ufuk Emre Keskin, Ufuk Emre Keskin Thoracic Surgery Clinic, Ankara Etlik City Hospital, Ankara, Turkey Search for other works by this author on: Oxford Academic PubMed Google Scholar Ömer Faruk Kapan, Ömer Faruk Kapan Thoracic Surgery Clinic, Ankara Etlik City Hospital, Ankara, Turkey Search for other works by this author on: Oxford Academic PubMed Google Scholar Serdar Han Serdar Han Thoracic Surgery Clinic, Ankara Etlik City Hospital, Ankara, Turkey Search for other works by this author on: Oxford Academic PubMed Google Scholar European Journal of Cardio-Thoracic Surgery, Volume 64, Issue 5, November 2023, ezad356, https://doi.org/10.1093/ejcts/ezad356 Published: 27 October 2023 Article history Published: 27 October 2023 Corrected and typeset: 01 November 2023

Journal Article Could we really provide an objective assessment in virtual reality lobectomy simulator to show the competency of video-assisted thoracoscopic lobectomy? Get access Tevfik Kaplan, Tevfik Kaplan Department of Thoracic Surgery, Lokman Hekim University School of Medicine, Ankara, Turkey Corresponding author. Department of Thoracic Surgery, Lokman Hekim University School of Medicine, Lokman Hekim Ankara Hospital, Andicen Mah, Polatlı 2 Cad., Idil Sok. No. 44, Sincan, Ankara 06930, Turkey. Tel: +90-312-58970-00/3631; e-mail: tevfikkaplan@yahoo.com (T. Kaplan). https://orcid.org/0000-0002-4936-1515 Search for other works by this author on: Oxford Academic PubMed Google Scholar Serdar Han Serdar Han Department of Thoracic Surgery, Lokman Hekim University School of Medicine, Ankara, Turkey Search for other works by this author on: Oxford Academic PubMed Google Scholar European Journal of Cardio-Thoracic Surgery, Volume 62, Issue 6, December 2022, ezac518, https://doi.org/10.1093/ejcts/ezac518 Published: 25 October 2022 Article history Received: 09 October 2022 Accepted: 24 October 2022 Published: 25 October 2022 Corrected and typeset: 07 November 2022

Aim: Solitary fibrous tumors (SFTs) are sporadic mesenchymal neoplasms that typically arise from visceral or parietal pleura.SFTs are rarely localized into the lung parenchyma while accounting <%5 of all pleural tumors.A few cases have been reported on this location in the literature.SFTs are not related to environmental factors such as tobacco smoking or asbestos exposure, unlike to the other tumors of lung and mesothelium.Case: Herein, we describe a forty six year-old woman with solitary fibrous tumor located in the superior segment of the right lower lung lobe. Conclusion:We are presenting this case because of its morphological findings that cause problems in differantial diagnosis and also its rare localization.

Background/aim The aim of this study was to measure the volume of interscalene space in thoracic outlet region on cadavers and radiological images and to analyze the potential value of these measurements in diagnosis and treatment of thoracic outlet syndrome (TOS). Materials and methods The dimensions of the anterior interscalene space in 8 formalin-fixed human cadavers were studied by direct measurement and additionally evaluation of the volume of this space were done by using mold and volume calculation formula of square pyramid, due to resembling a pyramid. In the second phase of this study, interscalene space volume was calculated by formula and compared to calculations from computed tomography (CT) sections in 18 TOS and 16 control patients. Results There was a strong correlation between the volume calculated by formula (4.79 ± 2.18 cm3) and by mold (4.84 ± 1.58 cm3), (R = 0.934, p = 0.001) in cadavers. The average volume measured in TOS patients (2.05 ± 0.32 cm3) was significantly smaller than control patients (4.30 ± 1.85 cm3, p < 0.0001). There were excellent or good results in 14 patients whereas in 4 patients who had neurogenic TOS achieved fair results after surgery. In these 4 patients the average volumes of abnormal sides were close to the healthy sides. Conclusion In our study, volume of interscalene space in TOS patients was statistically smaller than control group. Also, the volume was even smaller in patients with excellent or good results after surgery. In this respect, volumetric measurements from CT sections could be used in diagnosis and treatment selection in TOS patients.

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare disease which needs a long time for diagnosis and usually defined by case reports and small series. We reported two cases, one with 67 and the other with 66-years-old, both of them were female. They presented with long-lasting complaints of cough and shortness of breath. Computed tomography of patients showed multiple nodules on the basis of lungs, and additionally, mosaic perfusion was seen in the first case. Tissue samples were taken with video-assisted thoracic surgery, and the patients were diagnosed with DIPNECH by immunohistochemical examination. We wanted to emphasize the importance of DIPNECH which is a rare clinical entity causing chronic respiratory symptoms which should be considered in differential diagnosis of multiple pulmonary nodules.

Background The aim of this study was to evaluate the results of R0 resection of thymoma to identify prognostic factors for long-term outcomes. Methods Data of 62 patients (28 male, 34 female) with a mean age of 47.26 ± 14.42 years, who underwent R0 resection for thymoma and were followed-up between February 2004 and March 2016, were analyzed retrospectively. Results Eight patients had a video-assisted thoracoscopic thymectomy and 54 had a transsternal extended thymectomy. During a mean follow-up of 128.67 ± 7.95 months, regional recurrence of thymoma was observed in 9 (14.5%) patients. Overall 5- and 10-year survival rates were 85.36% and 78.20%, respectively. The 5- and 10-year survival rates in patients aged < 50 years were significantly better than in those aged ≥ 50 years (92% and 72% vs. 88% and 39%, p < 0.0001). The 10-year overall survival of patients in Masaoka stage I and II was better than those in stage III (88.9%, 78.4%, 69.8%, respectively, log-rank p < 0.001). The 10-year survival of patients with World Health Organization histological type A, AB, and B1 thymomas was better than those with type B2 and B3 (log-rank test p < 0.001). In multivariate analysis, age < 50 years ( p = 0.001), Masaoka stage ( p = 0.006), histological type ( p = 0.001), and recurrence ( p = 0.04) were independent prognostic factors for survival. Conclusion Our study indicates that age < 50 years, Masaoka stage, histological type, and recurrence are the determinants of survival in surgically resected cases of thymoma.

OBJECTIVES:The purposes of this study were to identify possible compression points along the transit route of the subclavian artery and to provide a detailed anatomical analysis of areas that are involved in the surgical management of the thoracic outlet syndrome (TOS). The results of the current study are based on measurements from cadavers, computed tomography (CT) scans and dry adult first ribs. METHODS:The width and length of the interscalene space and the width of the costoclavicular passage were measured on 18 cervical dissections in 9 cadavers, on 50 dry first ribs and on CT angiography sections from 15 patients whose conditions were not related to TOS. RESULTS:The average width and length of the interscalene space in cadavers were 15.28 ± 1.94 mm and 15.98 ± 2.13 mm, respectively. The widths of the costoclavicular passage (12.42 ± 1.43 mm) were significantly narrower than the widths and lengths of the interscalene space in cadavers (P < 0.05). The average width and length of the interscalene space (groove for the subclavian artery) in 50 dry ribs were 15.53 ± 2.12 mm and 16.12 ± 1.95 mm, respectively. In CT images, the widths of the costoclavicular passage were also significantly narrower than those of the interscalene space (P < 0.05). The measurements from cadavers, dry first ribs and CT images were not significantly different (P > 0.05). CONCLUSIONS:Our results showed that the costoclavicular width was the narrowest space along the passage route of the subclavian artery. When considering the surgical decompression of the subclavian artery for TOS, this narrowest area should always be kept in mind. Since measurements from CT images and cadavers were significantly similar, CT measurements may be used to evaluate the thoracic outlet region in patients with TOS.

OBJECTIVEThe aim of this study was to assess the cardiac and respiratory functions at the 6th postoperative month, in lung cancer patients undergoing segmentectomy/lobectomy or pneumonectomy.METHODSThirteen segmentectomy/lobectomy and 5 pneumonectomy patients with lung cancer were consecutively enrolled between April 2012 and February 2014. All patients underwent respiratory function tests and transthoracic echocardiography preoperatively and at 6 months postoperatively.RESULTSLeft ventricular functions were unchanged postoperatively. In the segmentectomy/lobectomy group, there were no changes in right ventricular fractional area change (RVFAC) or tricuspid annular plane systolic excursion (TAPSE). However, TAPSE decreased from 19 (17-21) to 15.5 (14-16) in pneumonectomy patients (p=0.04). RVFAC was 59.5 (58-61) preoperatively and 59 (58-61) at 6 months postoperatively (p=0.049). Neither group showed differences in pulmonary acceleration time or diastolic and systolic eccentricity indices after operation. Tissue Doppler imaging (TDI) revealed no deterioration in left ventricular functions, but right ventricular diastolic functions (tricuspid E'/A') were impaired in both groups. Right ventricular S', showing the systolic function, was slightly decreased in the pneumonectomy group, in addition to a decrease in isovolumic velocity and isovolumic acceleration (IVA). Only IVA was decreased, from 2.33 (1.79-3.14) to 2.17 (1.73-3.01) (p=0.001), in segmentectomy/lobectomy group.CONCLUSIONSegmentectomy/lobectomy should be preferred over pneumonectomy when possible. Tissue Doppler imaging may be routinely used as a part of echocardiographic evaluation in patients with a higher risk of right ventricular dysfunction in order for these patients to be candidates for a closer cardiovascular follow-up.

Tüm dünyada özofagus kanseri, kansere bağlı ölümlerin en sık altıncı nedenidir.Özofagus kanseri için tedavinin temeli halen özofagus rezeksiyonudur.Özofajektomi sonrası operatif mortalite son yıllarda azalırken, postoperatif morbidite hala önemli bir sorundur

BACKGROUND The aim of this study was to evaluate the pulmonary reserve of the patients via preoperative quantitative computerized tomography (CT) and to determine if these preoperative quantitative measurements could predict the postoperative pulmonary morbidity. METHODS Fifty patients with lung cancer who underwent lobectomy/segmentectomy were included in the study. Preoperative quantitative CT scans and pulmonary function tests data were evaluated retrospectively. We compare these measurements with postoperative morbidity. RESULTS There were 32 males and 18 females with a mean age of 54.4±13.9 years. Mean total density was -790.6±73.4 HU. The volume of emphysematous lung was (<-900 HU) 885.2±1,378.4 cm(3). Forced expiratory volume in one second (FEV1) (r=-0.494, P=0.02) and diffusion capacity of carbon monoxide (DLCO) (r=-0.643, P<0.001) were found to be correlate with the volume of emphysematous lung. Furthermore FEV1 (r=0.59, P<0.001) and DLCO (r=0.48, P<0.001) were also found to be correlate with mean lung density. Postoperative pulmonary morbidity was significantly higher in patients with lower lung density (P<0.001), larger volume of emphysema (P<0.001) and lower DLCO (P=0.039). A cut-off point of -787.5 HU for lung density showed 86.96% sensitivity and 81.48% specificity for predicting the pulmonary morbidity (kappa =-0.68, P<0.001). Additionally a cut-off point of 5.41% for emphysematous volume showed 84.00% sensitivity and 80.00% specificity for predicting the pulmonary morbidity (kappa =0.64, P<0.001). According to logistic regression analyses emphysematous volume >5.41% (P=0.014) and lung density <-787.5 HU (P=0.009) were independent prognostic factors associated with postoperative pulmonary morbidity. CONCLUSIONS In this study, the patients with a lower lung density than -787.5 HU and a higher volume of emphysema than 5.41% were found to be at increased risk for developing postoperative pulmonary morbidity. More stringent precautions should be taken in those patients that were found to be at high risk to avoid pulmonary complications.